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The Department of Health and Human Services wants all Americans to be able to access their health records electronically. Health care providers that participated in HHS's Medicare Electronic Health Record Incentive Program offered nearly 9 out of 10 patients the ability to access their health information online.

We found that relatively few of these patients accessed their records online, and patients typically did so in response to a medical visit. We also found that HHS doesn't know how effective its efforts to increase online access have been. We recommended HHS develop performance measures to assess the effectiveness of these efforts.

Average Percentage of Patients of Hospitals and Health Care Professionals that Participated in the 2015 Medicare EHR Program Who Were Offered Access and Electronically Accessed Health Information

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What GAO Found

Since 2009, the Department of Health and Human Services (HHS) has invested over $35 billion in health information technology, including efforts to enhance patient access to and use of electronic health information. One of the largest programs is the Centers for Medicare & Medicaid Services' (CMS) Medicare Electronic Health Record Incentive Program (Medicare EHR Program), which, among other things, encourages providers to make electronic health information available to patients. Program data for 2015 show that health care providers that participated in the program (3,218 hospitals and 194,200 health care professionals such as physicians) offered most of their patients the ability to electronically access health information. Patients generally described this access as beneficial, but noted limitations such as the inability to aggregate their longitudinal health information from multiple sources into a single record.

Data from the 2015 Medicare EHR Program show that relatively few patients electronically access their health information when offered the ability to do so. Patients GAO interviewed described primarily accessing health information before or after a health care encounter, such as reviewing the results of a laboratory test or sharing information with another provider.

Average Percentage of Patients of 2015 Medicare EHR Program Participating Providers Who Were Offered Access and Electronically Accessed Available Health Information

While HHS has multiple efforts to enhance patients' ability to access their electronic health information, it lacks information on the effectiveness of these efforts. The Office of the National Coordinator for Health Information Technology (ONC) within HHS collaborates with CMS to assess CMS's Medicare EHR Program as well as its own efforts to enhance patient access to and use of electronic health information. However, ONC has not developed outcome measures for these efforts consistent with leading principles for measuring performance. Without such measures, HHS lacks critical information necessary to determine whether each of its efforts are contributing to the department's overall goals, or if these efforts need to be modified in any way.

Why GAO Did This Study

HHS's goal is that all Americans will be able to electronically access their longitudinal health information, that is, their health information over time. HHS's efforts to achieve this goal include the Medicare EHR Program and other efforts to encourage providers to make patient health information available and for patients to access such information.

GAO was asked to review the state of patients' electronic access to their health information. This report (1) describes the electronic access to health information available to patients, and patients' views of this access, (2) describes the extent to which patients electronically access their health information, and actions providers reported taking to encourage such access, and (3) evaluates HHS's efforts to advance patients' ability to electronically access their health information. GAO analyzed data from HHS and other sources; reviewed applicable strategic planning documents; surveyed a generalizable sample of providers that participated in the Medicare EHR program; and interviewed HHS officials and a nongeneralizable sample of patients, providers, and health information technology product developers.

What GAO Recommends

GAO recommends that HHS 1) develop performance measures to assess outcomes of key efforts related to patients' electronic access to longitudinal health information, and 2) use the information from these measures to help achieve program goals. HHS concurred with the recommendations.

For more information, contact Carolyn Yocom at (202) 512-7114 or yocomc@gao.gov.

Recommendations for Executive Action

Status: Open

Comments: ONC has said it is in the process of developing an evaluation plan for its key efforts related to patients' access to longitudinal health information. ONC said it hopes to finalize this plan in 2018. As of September, 2018, it has not done so. Once ONC has developed its evaluation plan, we expect that we will be able to close this recommendation if the plan includes performance measures to assess outcomes of key efforts related to patients' electronic access to longitudinal health information.

Recommendation: To help ensure that its efforts to increase patients' electronic access to health information are successful, the Secretary of HHS should direct ONC to develop performance measures to assess outcomes of key efforts related to patients' electronic access to longitudinal health information. Such actions may include, for example, determining whether the number of providers that participate in these initiatives have higher rates of patient access to electronic health information.

Agency Affected: Department of Health and Human Services

Status: Open

Comments: ONC has said it is in the process of developing an evaluation plan for its key efforts related to patients' access to longitudinal health information. ONC said it hopes to finalize this plan in 2018. As of September, 2018, it has not done so. Once ONC has developed its evaluation plan, we will have to determine whether performance measures in the plan satisfy recommendation 1 and whether ONC has indicated, in the plan or elsewhere, how it intends to use the information the performance measures provide to make program adjustments, as appropriate.

Recommendation: To help ensure that its efforts to increase patients' electronic access to health information are successful, the Secretary of HHS should direct ONC to use the information these performance measures provide to make program adjustments, as appropriate. Such actions may include, for example, assessing the status of program operations or identifying areas that need improvement in order to help achieve program goals related to increasing patients' ability to access their health information electronically.